Kanbay Mehmet, Brinza Crischentian, Ozbek Lasin, Unlu Selen, Abdel-Rahman Sama Mahmoud, Guldan Mustafa, Aktas Ozgur, Covic Andreea, Burlacu Alexandru, Covic Adrian
Department of Medicine, Division of Nephrology, Koc University School of Medicine, 34010, Istanbul, Turkey.
Faculty of Medicine, University of Medicine and Pharmacy "Grigore T Popa", 700115, Iasi, Romania.
Int Urol Nephrol. 2025 May 10. doi: 10.1007/s11255-025-04572-5.
Pregnancy in kidney transplant recipients involves complex physiological changes that could potentially impact long-term graft function and survival. Despite some evidence suggesting minimal long-term effects on graft survival, conflicting results on graft function and timing-related risks highlight the need for a comprehensive review. This systematic review and meta-analysis aims to evaluate long-term impact of pregnancy on patient survival, graft failure, serum creatinine levels, estimated glomerular filtration rate (eGFR), and proteinuria in kidney transplant recipients.
We conducted a systematic review and meta-analysis adhering to PRISMA guidelines and registered with PROSPERO (CRD42024569702). We searched PubMed, Scopus, Web of Science, Cochrane Library, and Ovid MEDLINE. Studies were eligible if they provided data on adult kidney transplant recipients (> 18 years) who became pregnant post-transplant and included a control group of non-pregnant or non-conceived individuals.
Among the 6118 results screened, 19 studies met the eligibility criteria and were included in the meta-analysis. The risk of allograft failure or graft loss was similar between pregnant and non-pregnant controls (OR 1.13, 95% CI 0.83-1.53, p = 0.43), with a slightly higher adverse outcome rate in pregnant patients (25.4 vs. 19.8%). All-cause mortality risk was also comparable (OR 0.63, 95% CI 0.38-1.07, p = 0.09), with low heterogeneity (I = 12%). Creatinine levels were significantly lower before pregnancy compared to after delivery (SMD - 0.33, 95% CI - 0.52 to - 0.14, p = 0.0008).
Pregnancy in kidney transplant recipients leads to increased creatinine levels in postpartum but does not significantly affect long-term graft survival. While creatinine levels generally decrease during pregnancy, they show variability by trimester. The risk of allograft failure and mortality is similar between pregnant and non-pregnant recipients though adverse outcomes are slightly more frequent in pregnant patients, emphasizing the need for an optimal follow-up protocol of pregnant transplant recipients that takes trimester-specific graft function variations into consideration and that establishes clear thresholds for further evaluation and timely intervention.
肾移植受者怀孕涉及复杂的生理变化，这可能会对移植肾的长期功能和存活产生潜在影响。尽管有证据表明对移植肾存活的长期影响最小，但关于移植肾功能和与时间相关风险的相互矛盾的结果凸显了进行全面综述的必要性。本系统综述和荟萃分析旨在评估怀孕对肾移植受者的患者存活、移植肾失功、血清肌酐水平、估计肾小球滤过率（eGFR）和蛋白尿的长期影响。
我们按照PRISMA指南进行了系统综述和荟萃分析，并在PROSPERO（CRD42024569702）注册。我们检索了PubMed、Scopus、Web of Science、Cochrane图书馆和Ovid MEDLINE。如果研究提供了关于移植后怀孕的成年肾移植受者（>18岁）的数据，并包括未怀孕或未受孕个体的对照组，则该研究符合纳入标准。
在筛选的6118项结果中，19项研究符合纳入标准并被纳入荟萃分析。怀孕和未怀孕对照组之间移植肾失功或移植肾丢失的风险相似（OR 1.13，95%CI 0.83-1.53，p = 0.43），怀孕患者的不良结局发生率略高（25.4%对19.8%）。全因死亡风险也相当（OR 0.63，95%CI 0.38-1.07，p = 0.09），异质性较低（I = 12%）。与产后相比，怀孕前肌酐水平显著降低（SMD -0.33，95%CI -0.52至-0.14，p = 0.0０08）。
肾移植受者怀孕导致产后肌酐水平升高，但对移植肾的长期存活没有显著影响。虽然肌酐水平在怀孕期间通常会降低，但在不同孕期存在差异。怀孕和未怀孕受者之间移植肾失功和死亡的风险相似，尽管怀孕患者的不良结局略多，这强调了需要为怀孕的移植受者制定最佳的随访方案，该方案应考虑到不同孕期移植肾功能的变化，并建立明确的进一步评估和及时干预阈值。
